Sri Lanka Health System Review by Alexander Pascual

Sri Lanka Health System Review

6.1 Analysis of the significant health reforms that affected health developments in Sri Lanka The reforms date back to 1926 when the MOH system was established. The principal reforms in Sri Lanka are described in Table 6.1 and can be categorized with reference to the six health systems building blocks. Although almost all these policies change the impact of multiple building blocks of the system, each is seen to have an impact on one component more than the rest. These reforms include the following: a. governance: legislation of the Health Service Act 1952; regulation of the private sector in 2006; addressing health risks such as the tobacco and alcohol policy in 2006; and establishing the framework for prevention and control of NCDs in 2009; b. medicines and medical products: establishment of the NMRA in 2015; c. health workforce: dual practice policy in 1977; establishment of HR coordinating division in 2016; d. health delivery systems: decentralization of health services to the provincial health departments in 1987; establishment of a DGH in each district in 2000; and policy towards health service delivery for UHC in 2018; and e. HIS strengthening in 2016. Table 6.1 Major health-care reforms and policy measures Year

Reform

1926

Establishment of health unit (Medical Officer of Health) system

1952

Health Services Act (No. 12 of 1952)

1977

Dual practice*

1987

Decentralization of health services and establishment of provincial health departments

1991

Management reform to amalgamate preventive and curative care services in keeping with local administrative boundaries

2000

Development of one hospital to the level of a district general hospital for each district

2005

National Medicinal Drug Policy

2006

Private Health Sector Regulation Act

2006

National Authority on Tobacco and Alcohol

2009

National Policy and Strategic Framework for Prevention and Control of Chronic NonCommunicable Diseases

2013

National Migration Health Policy

2016

Establishment of National Human Resource Coordinating Division

2017

National Policy on Health Information

2018

Policy on Health Service Delivery for UHC

* Government health professionals are allowed to engage in private practice during off hours. Source: Compiled by the authors

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Sri Lanka Health System Review

Articles inside

9. Appendices ................................................................................................ 206 9.1 References

9.3 About the authors

7.6 Transparency and accountability

9.2 HiT methodology and production process

7.4 Health outcomes, health service outcomes and quality of care

7.3 User experience and equity of access to health care

7.1 Objectives of the health system

7. Assessment of the health system .......................................................... 157 Chapter summary

6.3 Future developments

developments in Sri Lanka

6.2 Analysis of recent major reforms

6. Principal health reforms ......................................................................... 139 Chapter summary

medicine

5.11 Mental health care

5.13 Health services for specific populations

5.8 Rehabilitation

5.7 Pharmaceutical care

5.6 Emergency care

5.2 Curative care services

5.4 Inpatient care

4.2 Human resources

5. Provision of services ................................................................................ 113 Chapter summary

4.1 Physical resources

4. Physical and human resources ................................................................ 78 Chapter summary

3.7 Payment mechanisms

3.6 Other financing

Figure 3.8 OOP spending on health by expenditure deciles, 2016

3.5 Voluntary private health insurance

3.2 Sources of revenue and financial flows

3.3 Overview of the public financing schemes

Figure 3.6 Financing system related to health-care provision

3. Health financing ......................................................................................... 48 Chapter summary

2.9 Patient empowerment

2.8 Regulation

2.7 Health information management

2.6 Intersectorality

2.4 Decentralization and centralization

2.2 Overview of the health system

2.1 Historical background

2.3 Organization

2. Organization and governance ................................................................... 26 Chapter summary

1. Introduction .................................................................................................. 1 Chapter summary

1.4 Health status

1.3 Political context

1.5 Human-induced and natural disasters

Figure 1.1 Map of Sri Lanka

1.1 Geography and sociodemography

1.2 Economic context

1 Analysis of the significant health reforms that affected health